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Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction
Myocardial infarction (MI) is defined as myocardial cell death due to prolonged myocardial ischemia. Clinically, troponin rise and/or fall have become the “defining feature of MI” according to the universal definition of MI (UD-MI). Takotsubo syndrome (TS) and TS-related disease conditions also caus...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Baishideng Publishing Group Inc
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383352/ https://www.ncbi.nlm.nih.gov/pubmed/32774776 http://dx.doi.org/10.4330/wjc.v12.i6.231 |
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author | Y-Hassan, Shams |
author_facet | Y-Hassan, Shams |
author_sort | Y-Hassan, Shams |
collection | PubMed |
description | Myocardial infarction (MI) is defined as myocardial cell death due to prolonged myocardial ischemia. Clinically, troponin rise and/or fall have become the “defining feature of MI” according to the universal definition of MI (UD-MI). Takotsubo syndrome (TS) and TS-related disease conditions also cause troponin elevation with typical rise and/or fall pattern but through a mechanism other than coronary ischemia. By strict application of the clinical diagnostic criteria for type-1 MI, type-2 MI, type-3 MI, and MI with non-obstructive coronary arteries according to the UD-MI including the fourth one published recently, TS and most of the 26 other causes of troponin elevation mentioned in the fourth UD-MI may erroneously be classified as MI. The existing evidence argues for the case that TS by itself is not a MI. Hyper-activation of the autonomic-sympathetic nervous system including local cardiac sympathetic hyper-activation and disruption with nor-epinephrine churn and spillover is the most probable cause of TS. This autonomic neuro-cardiogenic (ANCA) mechanism results in myocardial “cramp” (stunning), the severity and duration of which depend on the degree of the sympathetic-hyperactivation and nor-epinephrine spillover. The myocardial cramp may squeeze the cytosolic free troponin pools causing mild to moderate troponin elevation in TS and TS-related disease conditions. This ANCA syndrome, which has hitherto been enveloped by the UD-MI over more than one decade, may occur in acute, recurrent, and chronic forms. In this critical review, the controversies of UD-MI, evidence for ANCA syndrome, and a hypothetical mechanism for the troponin elevation in ANCA syndrome are provided. |
format | Online Article Text |
id | pubmed-7383352 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-73833522020-08-07 Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction Y-Hassan, Shams World J Cardiol Review Myocardial infarction (MI) is defined as myocardial cell death due to prolonged myocardial ischemia. Clinically, troponin rise and/or fall have become the “defining feature of MI” according to the universal definition of MI (UD-MI). Takotsubo syndrome (TS) and TS-related disease conditions also cause troponin elevation with typical rise and/or fall pattern but through a mechanism other than coronary ischemia. By strict application of the clinical diagnostic criteria for type-1 MI, type-2 MI, type-3 MI, and MI with non-obstructive coronary arteries according to the UD-MI including the fourth one published recently, TS and most of the 26 other causes of troponin elevation mentioned in the fourth UD-MI may erroneously be classified as MI. The existing evidence argues for the case that TS by itself is not a MI. Hyper-activation of the autonomic-sympathetic nervous system including local cardiac sympathetic hyper-activation and disruption with nor-epinephrine churn and spillover is the most probable cause of TS. This autonomic neuro-cardiogenic (ANCA) mechanism results in myocardial “cramp” (stunning), the severity and duration of which depend on the degree of the sympathetic-hyperactivation and nor-epinephrine spillover. The myocardial cramp may squeeze the cytosolic free troponin pools causing mild to moderate troponin elevation in TS and TS-related disease conditions. This ANCA syndrome, which has hitherto been enveloped by the UD-MI over more than one decade, may occur in acute, recurrent, and chronic forms. In this critical review, the controversies of UD-MI, evidence for ANCA syndrome, and a hypothetical mechanism for the troponin elevation in ANCA syndrome are provided. Baishideng Publishing Group Inc 2020-06-26 2020-06-26 /pmc/articles/PMC7383352/ /pubmed/32774776 http://dx.doi.org/10.4330/wjc.v12.i6.231 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Review Y-Hassan, Shams Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction |
title | Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction |
title_full | Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction |
title_fullStr | Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction |
title_full_unstemmed | Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction |
title_short | Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction |
title_sort | autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383352/ https://www.ncbi.nlm.nih.gov/pubmed/32774776 http://dx.doi.org/10.4330/wjc.v12.i6.231 |
work_keys_str_mv | AT yhassanshams autonomicneurocardiogenicsyndromeisstonewalledbytheuniversaldefinitionofmyocardialinfarction |